Showing papers by "Centers for Disease Control and Prevention published in 1980"

Trichomonas vaginalis: Reevaluation of Its Clinical Presentation and Laboratory Diagnosis

Abstract: Vaginal discharge is the most common complaint and Trichomonas vaginalis vaginitis the most frequently diagnosed problem among women attending the DeKalb County Georgia, Veneral Disease Clinic. Despite this prevalence, the 1837 observations of Donne are the criteria frequently used in the clinical and laboratory diagnosis of trichomoniasis. Our study shows that a purulent, frothy discharge is indeed a characteristic of trichomonal vaginitis, but if it is used as the sole diagnostic criterion, 88% of women with trichomonal vaginitis will not be identified and 29% will be erroneously diagnosed as infected. Donne's wet-mount test remains highly specific, but culture will detect twice as many trichomonas infections. There is a positive association between trichomoniasis and gonococcal cervicitis, failure to use contraceptive techniques, and lack of yeast in the wet mount of vaginal secretions.

A two-year study of bacterial, viral, and parasitic agents associated with diarrhea in rural Bangladesh

Abstract: A 2 year study of enteric pathogens associated with diarrhea was conducted at a diarrhea treatment center in rural Bangladesh. (ETEC) Enterotoxigenic Escherichia coli was the most frequently identified pathogen in patients of all ages whereas rotavirus was isolated from nearly 50% of the < 2 year old patients. ETEC was isolated in approximately 25% of these young children. A bacterial or viral pathogen was identified for 70% of the < 2 year olds and for 56% of all patients with diarrhea. Most ETEC isolates were obtained in the hot dry months of March-April and the hot wet months of August-September. Rotavirus identification peaked in the cool dry months of December-January but infected patients were found year round. The low case fatality rates for patients with watery diarrhea and substantial dehydration further documents the usefulness of treating diarrhea patients with either a glucose or sucrose base electrolite solution such as those used in this treatment center. (Authors modified)

Pittsburgh Pneumonia Agent: Direct Isolation from Human Lung Tissue

Abstract: Pittsburgh pneumonia agent (PPA) was recently cultivated from infected egg yold on charcoal yeast extract agar. PPA has now been isolated both from infected egg yolk and human lung tissue on charcoal yeast extract agar and on a new medium, buffered charcoal yeast extract agar. PPA resembles Legionella pneumophila and other Legionella-like organisms in requirements for growth and composition of fatty acids. It differs in genetic relatedness, antigenic composition, and colonial morphology and has distinctive characteristics that allow it to be identified. The name Legionella pittsburgensis species nova is proposed for this organism.

Study on the efficacy of nosocomial infection control (senic project): summary of study design

Abstract: With the emergence of nosocomial infections as a serious problem among US hospitals, the Center for Disease Control undertook in 1974 a nationwide study to evaluate approaches to infection control. The three-phased project, now known as the Study on the Efficacy of Nosocomial Infection Control, or SENIC Project, was designed with three primary objectives: 1) to determine whether (and, if so, to what degree) the implementation of infection surveillance and control programs (ISCPs) has lowered the rate ofnosocomi al infection, 2) to describe the current status of ISCPs and infection rates, and 3) to demonstrate the relationships among characteristics of hospitals and patients, components of ISCPs, and changes in the infection rate. With data collection completed in a nationally representative sample of hospitals, analysis is underway to identify approaches to infection control that are most effective for the least cost to hospitals and to point out additional specific questions to be answered by future research.

Plasmid-mediated tissue invasiveness in Yersinia enterocolitica.

Abstract: Plasmids have an important role in the pathogenicity of certain bacterial species, and Escherichia coli provides the most complete example of the relationship involved. Enterotoxigenic strains of E. coli, in addition to producing heat-stable and/or heat-labile enterotoxins, may also produce a haemolysin and fimbriate cell surface antigens which facilitate the adherence of the bacterial cell to the mucosa of the small bowel. Numerous studies have shown that these properties are plasmid-mediated1–5 and that the plasmids act in concert to confer on the host bacterium the ability to produce enteric disease in man and in animals. Moreover, studies with invasive strains of E. coli have shown that the Col V plasmid, which codes for the synthesis of colicin V, significantly enhances the pathogenicity of its host bacterium6,7. Although the relationship between Col V plasmids and virulence is unclear, reports indicate that Col V-containing strains of E. coli are better able to survive in the alimentary tract and that colicine V itself inhibits macrophage function7,8. It is probable that bacterial virulence is a complex phenomenon involving both chromosomal and plasmid genes. We describe here a virulence plasmid which mediates tissue invasiveness in human pathogenic strains of Yersinia enterocolitica.

Lassa Virus Infection of Rhesus Monkeys: Pathogenesis and Treatment with Ribavirin

Abstract: Rhesus monkeys were experimentally infected with Lassa virus to establish their suitability as a nonhuman primate model for the human disease and to test the protective efficacy of ribavirin, an antiviral drug. Six of 10 untreated control monkeys died after subcutaneous inoculation of 10(6.1) plaque-forming units of Lassa virus (strain Josiah). Infectivity titrations of tissue homogenates from the six dead monkeys indicated significant replication in all tissues tested except the central nervous system. This distribution of virus was confirmed by direct immunofluorescence examination of cryostat-sectioned tissues. Ribavirin was beneficial in the treatment of two groups of infected monkeys. Four monkeys first treated on the day of viral inoculation experienced only mild clinical disease; four monkeys first treated five days later experienced a more severe illness. None of the eight monkeys treated with ribavirin died. Viremia titers and elevations of levels of serum transaminases in treated monkeys were significantly lower than in controls. Ribavirin may be beneficial in the treatment of humans exposed to this life-threatening virus.

Ebola Hemorrhagic Fever: Tandala, Zaire, 1977–1978

Abstract: Ebola virus was recovered from a nine-year-old girl who died of acute hemorrhagic fever in June 1977 at Tandala Hospital in northwestern Zaire, in the first reported recognized case of this disease since the discovery epidemics of 1976 in Zaire and Sudan. Investigations undertaken in the Tandala region revealed that two previous clinical infections with Ebola virus had occurred in 1972 and that about 7% of the residents had immunofluorescent antibodies to the virus. Females younger than 30 years of age had a higher prevalence of antibodies than males of comparable age, but above the age of 30 years there was no sex difference. No other clues to the still-mysterious natural reservoir of Ebola virus were uncovered.

Estimating the Extra Charges and Prolongation of Hospitalization Due to Nosocomial Infections: A Comparison of Methods

Abstract: Estimates of the economic consequences of nosocomial infections were derived by studying the same patient population with two different methods: physician's assessment and comparisons of patients with nosocomial infection and those without, matched on five characteristics. Estimates of extra days and extra routine charges obtained by the comparison were about 2 1/2 times greater than those obtained by the physician's assessment (P less than 0.0001). Even when the match of patients was exact and measures were taken to avoid confounding, patients with nosocomial infection had more discharge diagnoses recorded (P = 0.02) and experienced more episodes of pulmonary embolism, renal failure, and death in the hospital than did their counterparts. These differences suggest that, despite careful matching, the members of the pairs were not comparable in their intrinsic predisposition to prolonged hospitalization. Unless patients can be matched on this prediposition, the estimates from a comparison study will be exaggerated.

National Surveillance of Kawasaki Disease

Abstract: Information about 261 cases of Kawasaki disease (KD) was reported to the Center for Disease Control (CDC) between July 1976 and July 1978. KD occurred at all times of the year in young, previously healthy children throughout the United States. KD was more common in infants and toddlers, males, and Asian and part-Asian children. The illness was characterized by acute onset of prolonged high fever; maculopapular or scarlatiniform rash; adenopathy; injection of the conjunctival and mucous membranes of the upper respiratory tract; redness of the palms and soles; indurative edema of the extremities; desquamation, arthralgias; and elevated white blood cell count, erythrocyte sedimentation rate, and platelet count. Complications included gallbladder disease and carditis; 2.8% died. Surviving patients were hospitalized for a mean of 8.9 days.

Laser therapy of rheumatoid arthritis

Abstract: Thirty people with classical or definite rheumatoid arthritis received laser exposure to a Q-switch neodymium laser that operated at 1.06 micrometer with an output of 15 joules/cm2 for 30 nsec. One hand was lased at the proximal interphalangeal (PIP) and metacarpal phalangeal (MCP) joints, whereas the other hand was sham lased. The patient, physician, and occupational therapy evaluators did not know which hand was being lased. Twenty-one patients noted improvement of both their MCP and PIP joints of both hands during laser therapy. Twenty-seven noted improvement of their PIP joints and 26 noted improvement of the MCP joints during therapy. Heat, erythema, pain, swelling, and tenderness all improved with time in both hands, but the lased hand had more significant improvement in erythema and pain. There was also significant improvement in grasp and tip pressure on the lased side. The level of circulating immune complexes as measured by platelet aggregation decreased during lasing. The improvement may be related to laser exposure. The exact role that laser radiation has upon rheumatoid arthritis and its mechanism of action remain to be elucidated.

Pneumococcal bacteremia in charleston county, south carolina

Abstract: To describe the epidemiology of pneumococcal bacteremia in a large population, this study reviewed medical records for residents of Charleston County, South Carolina, who had pneumococci isolated from blood cultures during the period 1974-1976. The overall incidence of documented pneumococcal bacteremia was 8.5 cases per 100,000 population per year. It was highest for those in the first two years of life (35 per 100,000 per year) and those in their sixties (21 per 100,000 per year). The incidence was more than five times higher in blacks than in whites and within races appeared to be independent of socioeconomic status or population density. Seventy-three per cent of the cases occurred in persons with another medical problem. These data on the incidence of documented pneumococcal bacteremia underestimate the true incidence of bacteremia to the extent that blood cultures were not performed under optimal circumstances for all persons with compatible clinical syndromes. The data suggest that certain groups would benefit from vaccination against pneumococcal disease if the vaccines are shown to be safe and effective for these groups.

Necrotizing enterocolitis a prospective multicenter investigation

Abstract: Several pre- and post-natal factors possibly important in determining which infants will develop necrotizing enterocolitis (NEC) and which of these infants will die with this disease were prospectively studied in 1976 in 11 infants with radiographic or pathologic evidence of the disease from 12 institutions in the United States and 111 weight-matched, institution-matched control infants. By multivariant discriminant analysis, the authors idenfitied 10 independent significant determinants of NEC and 10 determinants predictive of a fatal outcome among case infants. Determinants of NEC were: Apgar score deterioration; presence of a patent ductus arteriosus; maternal receipt of anesthesia during delivery; infant not treated with parenteral gentamicin before the onset of disease; infant receipt of 10% dextrose solution; treatment of mother with antibiotics during pregnancy; hyperalimentation or gavage feedings; premature rupture of membranes. Important morbid events among cases included red blood cell transfusions, gas in the portal system, premature rupture of membranes, abdominal distension, isolation of Klebsiella organisms from the blood, surgery, prolonged perinatal oxygen requirement, and lower Apgar 2 score. Attempts to modify preventable risk factors may decrease the incidence (2.4 cases per 1000 live births) and case fatality (41%) documented in this study.

Isolation of Campylobacter fetus subsp. jejuni from Bangladeshi children

Abstract: To determine the prevalence of infection with Campylobacter fetus subsp. jejuni in Bangladesh, culture surveys were conducted among three populations. In Dacca, Campylobacter was isolated from 5.2% of 97 individuals with clinical dysentery and from 12.3% of 204 patients with only diarrhea. This difference may have resulted from a greater representation of young children in the second group. Campylobacter was isolated from 17.7% of the 141 healthy village children aged 1 to 5.5 years and from 38.8% of the 1-year-old children. More infected children (48%) had a history of recent diarrheal illness than did a group of matched controls (20%; P = 0.016). These findings suggest that campylobacter infection is common for Bangladeshi children. However, this organism may not cause diarrheal illness in all instances in which it is isolated.

Legionella micdadei species nova: Classification of a third species of Legionella associated with human pneumonia

Abstract: Deoxyribonucleic acid relatedness studies were used to characterize threeLegionella-like organisms; TATLOCK, HEBA, and the Pittsburgh pneumonia agent. The results showed that these three strains belong in the same species, which is distinct from the previously described speciesLegionella pneumophila andL. bozemanii. Legionella micdadei species nova is proposed for this new species. The type strain ofL. micdadei is TATLOCK (ATCC 33218).

Nasopharyngeal carcinoma in Alaskan Eskimos Indians, and Aleuts: a review of cases and study of Epstein-Barr virus, HLA, and environmental risk factors.

Abstract: The records of thirty-one patients with nasopharyngeal carcinoma (NPC) diagnosed from 1966 through 1976 among the Alaskan native population (Eskimo, Aleut, Indian) were reviewed. There were 25 males and six females, which results in relatively high incidence rates per 100,000 of 13.5 for males and 3.7 for females. Clinical and pathologic features were similar to those found among southern Chinese NPC patients. Five-year survival rate was 48%. Antibodies to Epstein-Barr virus were higher in NPC patients than in patients with other tumors or matched controls. On histocompatibility testing Sin-2 was not detected, nor was there significantly increased frequency of A2. Instead, BW40 and a second locus blank occurred more often among NPC patients than among other groups. In response to a questionnaire, NPC patients more often reported use of salt fish in the childhood diet, smoking of cigarettes, and exposure to noxious inhalants than did controls, but the differences were not statistically significant.

Epidemic salmonellosis from cheddar cheese: surveillance and prevention

Abstract: On August 3, 1976, ongoing Salmonella surveillance in Colorado first detected an epidemic of Salmonella heidelberg infections that eventually totaled 339 isolates. The majority of the cases occurred between July 23 and August 12 in two widely separated cities: Denver and Pueblo. Epidemiologic investigation successively incriminated 1) recent dining at Mexican-style restaurants (p less than 0.001), 2) eating foods containing cheese in these restaurants (p = 0.029), and 3) consumption of cheddar cheese from a single shipment of a single manufacturer (p less than 0.01). The prompt investigation enabled an embargo of 2087 kg (41%) of the contaminated cheese. S. heidelberg was isolated from seven production lots of the incriminated cheese. Surveillance and the epidemiologic investigation may have resulted in prevention of 25,000 diarrheal illnesses.

The accuracy of retrospective chart review in measuring nosocomial infection rates: results of validation studies in pilot hospitals

Abstract: To measure the accuracy and consistency of a standardized method--retrospective chart review (RCR)--for estimating nosocomial infection rates (NIRs) in individual hospitals, the authors performed a series of pilot studies in four hospitals of different types. In comparison with a standard based on diagnoses made by physician-epidemiologists supervising intensive prospective data collection teams, the RCR method was found to have an average sensitivity of 0.74 (+/- 0.02 SE; range 0.69-0.78) and an average specificity of 0.964 (+/- 0.002; 0.945-0.991). These values were comparable to those of the physician-epidemiologists' diagnoses and varied less among the hospitals. Two independent teams of chart reviewers were found to have similar levels of sensitivity and specificity, and the reliability of diagnosis at the level of the individual chart reviewer averaged 0.94. In a restudy at one of the pilot hospitals at the midpoint of the actual Medical Records Survey (MRS), there was a substantial increase in sensitivityand a slight increase in specificity as a result of improvements made in the RCR method after the original pilot studies.

Evaluation of Influenza A/Hong Kong/123/77 (H1N1) ts-1A2 and Cold-Adapted Recombinant Viruses in Seronegative Adult Volunteers

Abstract: Two attenuated influenza A donor viruses, the A/Udorn/72 ts-1A2 and the A/Ann Arbor/6/60 cold-adapted (ca) viruses, are being evaluated for their ability to reproducibly attenuate each new variant of influenza A virus to a specific and desired level by the transfer of one or more attenuating genes. Each of these donor viruses has been able to attenuate influenza A viruses belonging to the H3N2 subtype by the transfer of one or more attenuating genes. To determine whether these two donor viruses could attenuate a wild-type virus that belonged to a different influenza A subtype, ts-1A2 and ca recombinants of a wild-type virus representative of the A/USSR/77 (H1N1) Russian influenza strain were prepared and evaluated in adult doubly seronegative volunteers at several doses. The recombinants derived from both donor viruses were attenuated for the doubly seronegative adults. Less than 5% of infected vaccinees developed a febrile or systemic reaction, whereas five of six recipients of wild-type virus developed such a response. The 50% human infectious dose (HID(50)) for each recombinant was approximately 10(5.0) 50% tissue culture infective doses. The virus shed by the ts-1A2 and ca vaccinees retained the ts or ca phenotype, or both. This occurred despite replication of the recombinant viruses for up to 9 days. No evidence for transmission of the ca or ts-1A2 recombinant virus to controls was observed. A serum hemagglutination inhibition response was detected in less than 50% of the infected vaccinees. However, with the more sensitive enzyme-linked immunosorbent assay, a serological response was detected in 100% of the ca vaccinees given 300 HID(50) and approximately 70% of ca or ts vaccinees who received 10 to 32 HID(50) of virus. These results indicate that the recombinants derived from both donor viruses were satisfactorily attenuated and were stable genetically after replication in doubly seronegative adults although they induced a lower serum hemagglutination inhibition response than that found previously for H3N2 ts and ca recombinants.

Non-A/non-B hepatitis in experimentally infected chimpanzees: cross-challenge and electron microscopic studies.

Abstract: Inoculation of eight chimpanzees with factor VIII, factor IX, or “H” strain plasma resulted in enzymatic and histopathologic evidence of non-A/non-B hepatitis in all eight animals. Challenge of two chimpanzees convalescent from factor VIII-induced disease with either factor IX or “H” strain plasma resulted in non-A/non-B hepatitis only in the animal inoculated with factor IX materials. Reciprocal cross-challenge of a chimpanzee convalescent from factor IX-induced disease with factor VIII also produced unequivocal enzymatic and histopathologic evidence of non-A/non-B hepatitis. Cross-challenge of a chimpanzee convalescent from “H” strain-induced non-A/non-B hepatitis with factor VIII did not cause a second bout of non-A/non-B hepatitis. These findings suggest the factor VIII materials and “H” strain plasma used in these studies share a common etiologic agent (or agents), but that factor VIII and factor IX may contain two distinct agents. Electron microscopic (EM) examination of thin-sectioned, acute-phase liver biopsies from all but one of the chimpanzees receiving the primary inocula revealed the presence of abnormal hepatocyte cytoplasmic structures previously shown to be associated with non-A/non-B hepatitis. Crystalline structures containing 25 to 30 nm particles were visualized by EM in the cytoplasm of endothelial or Kupffer cells in acute-phase liver biopsies obtained from three chimpanzees inoculated with either factor VIII materials or “H” strain plasma.

Immunologic diagnosis of Legionnaires' disease: cross-reactions with anaerobic and microaerophilic organisms and infections caused by them.

Abstract: The hundred twenty-four isolates of anaerobic and microaerophilis organisms were examined with a polyvalent direct immunofluorescent antibody (DFA) reagent directed against Legionella pneumophila, serogroups (SG) I-IV. Three of 53 isolates of Bacteroides fragilis cross-reated with the SG I component of the reagent. Rabbit antisera to three SG I strains of L. pneumophila cross-reacted with these three B. fragilis isolates, and cross-reactivity was not due to preexisting rabbit antibodies; antisera to a fourth SG I strain did not cross-react with these isolates. Indirect fluorescent antibody (IFA) examinations of convalescent-phase sera from eight of 41 patients with B. fragilis group infections showed titers of greater than or equal to 1:128 or a fourfold or greater seroconversion against L. pneumophila, SG I. All eight patients had bacteremia due to B. fragilis, but five B. fragilis isolates available from these patients were DFA-negative. Thus, false-positive reactions may result from DFA as well as IFA examinations of sera from patients with B. fragilis infections.

Legionella gormanii sp. nov

Abstract: A new species of Legionella was isolated from soil collected from a creek bank. The name Legionella gormanii sp. nov. is proposed.